Injuries, Illnesses, and the Cost of Absences

Imagine this scenario: two teams participate in the same competition with roughly the same financial and human resources. 18 of United’s 20 players are available to train and play over the whole season. Meanwhile, only 15 of City’s players are available. The disparity in player availability between the teams is 15 percentage points (90% vs 75%). This situation generates negative costs for City in comparison to United.

Every coach, fitness coach, technical director, doctor, physiotherapist, and club executive recognises and comprehends this scenario, but do they know the current and historical situation in their respective teams and clubs? Do they understand the type of direct and indirect costs related to this phenomenon? And are they capable of managing those risks accordingly? Here, we argue why every person in these roles at all levels of sport should monitor and manage absences and related costs.

Definition of Absence

Reasons for absences can be divided into health- or non-health-related. In this post, we focus on the health-related absences. Injuries and illnesses are the two major categories identified as a cause for health-related absences. Instead of focusing solely on the sheer number of injury or illness incidents, we should consider the length of absence periods following these incidents.

The term absence, in this context, should not necessarily be understood as a literal absence from a given event, but a restricted availability from their standard individual/team-training regime and expected competition requirements. For example, a player who is recovering from an injury may be able to participate in a training event with the rest of the squad but follows a separate rehabilitation exercise programme. Therefore, we argue that the definition of absence is a crucial initial step in handling these issues and so propose the adoption of the aforementioned ‘limited availability’ concept.

Illustration of Availability

A standardised injury monitoring protocol using the UEFA injury classification and focusing on days of absence (limited availability) has been implemented in a Finnish professional football club. Figure 1 illustrates the number of injury incidences reported at different stages of the season (the competitive season consisted three 11-game blocks) and the relative daily player availability rate. The significance of the availability rate is naturally relative to the squad size – a squad of 20 with 90% availability still has fewer players available than a squad of 25 with 80% availability.

Figure 1. Seasonal injury data from a Finnish Premier League club.
a) Number of reported injuries during Pre-Season (PS) and Competitive Season 1, 2, and 3 (CS1, CS2, CS3).
b) Daily availability rate. The green horizontal line represents the seasonal average for all days and the red line the average for match days. The black vertical lines mark the beginning and end of the Competitive Season.

Below, Table 1 shows the overall count of injuries and illnesses which resulted in more than 0 absence days (39 cases out of 49 reports). The table also shows the total absence days and average absence days associated with each type, thus showing the magnitude of harm resulting from each type of absence cause.

Table 1. Injury and illness types and costs (in absence days).

Direct Costs

Direct costs of absences vary according to level of the team

The most hurtful direct cost incurred coaching staff is the unavailability from squad selection for games, which has also been associated with negative match outcomes (Hägglund et al. 2013). Teams that are exposed to congested match fixtures have a higher likelihood of within- and between-player movement asynchrony (Folgado, Duarte, Marques, and Sampaio 2015) and injury occurrences (Bengtsson, Ekstrand, and Hägglund 2013). These teams have a clear incentive in attempting to maximise availability through player rotation and other methods.

Back on the training field, we might extend the above point to include negative developmental outcomes. Players who are unable to train fully are unable to adapt at the same rate and may therefore be at higher risk of injury (Gabbett 2016)

If absences are counted as days of limited availability – and thus unavailability for matches and regular team exercises – this means professional teams’ losses in terms of salaries paid. After all, professional players are generally paid solely for their availability and effort in those events. It is estimated that the average cost of absences for English Premier League clubs in the season 2016-17 was over £9 million (PhysioRoom 2017). Although the EPL is only the tip of the iceberg, the relative cost in proportion to the financial resources is tremendous. For all responsible club executives, technical directors, and everyone who involved in maintaining financial stability of an organisation – knowing and managing this cost is absolutely necessary.

Indirect Costs

While the direct costs of absences alone can be debilitating for clubs, the web of indirect costs expands much further, including those costs directly associated with the injury itself (rather than the absence) and those secondary costs occurring from the absence. Indirect costs can affect the work of various people within and without the team:

In particular, injuries that require medical interventions cost money to clubs and individuals either directly or through taxation and insurance premiums.

These cases usually also occupy clubs’ medical, sport science, and coaching staff’s time and attention. In smaller organisations, this may mean time away from preventing new health-related absences, as the member of staff allocates more time toward rehabilitation than prevention.

When coaches are forced to select their match squads from a narrower pool of players, the game loading distribution is skewed over time, which might increase the likelihood of injuries/illnesses to other players and subsequent absences. Also, the more frequent exposure to match loading may limit training opportunities for excessively loaded individuals. Naturally clubs may battle against this spiral of events by recruiting new players to replace absent ones, creating another type of cost.

Above all, the damage to the individual caused by injury can be dramatic. The significance of the trauma itself should not be ignored or treated only as a € sign. Further, such damage can expose players to a higher likelihood of recurrent injury, limit tolerance for a certain type of training, and naturally also decrease earning potential or indeed enjoyment in their given sport.

Conclusions

We have only addressed some of the most obvious scenarios of health-related absences generating costs. Each decision-maker (from coaches to executives) should at least ask the simple question: what are our direct costs of health-related absences? The answer is the first step toward understanding the value of the problem.

Seeing is the first step in understanding this issue more in-depth. In order to see, organisations need to have sufficient systems and processes to monitor absences. One of the key features in Quanter is the logging and tracking of injury/illness incidents, and having a real-time overview of the situation. But that is only the technical solution – equally important is the process of implementing the system and gaining insights from other data. Training load, sleep, nutrition, and other indicators also become more relevant when absence information is available and well organised. Understanding the daily histories preceding injury trends facilitates action to reduce risk in the future. Nobody is happy when an injury occurs and absence days increase – we should work to reduce this risk.

Are you ready to start monitoring and managing your team’s injury and illness data? Building on the successes of our monitoring protocol implemented through the 2017 Finnish football season, we are now looking to bring this standardised approach to new teams in new sports and at different levels. Download Quanter today and let’s start discussing the next steps!